Secondary Logo

Institutional members access full text with Ovid®

Share this article on:

The Safety and Efficacy of Laparoscopic Common Bile Duct Exploration Combined with Cholecystectomy for the Management of Cholecysto-choledocholithiasis: An Up-to-date Meta-analysis

Pan, Long, MD*,†; Chen, Mingyu, MD; Ji, Lin, PhD*; Zheng, Longbo, PhD*; Yan, Peijian, PhD*; Fang, Jing, MD*; Zhang, Bin, MD*,†; Cai, Xiujun, MD, PhD*,†

doi: 10.1097/SLA.0000000000002731

Objective: The aim of this study was to compare the efficacy and safety of the laparoscopic common bile duct exploration (LCBDE) and laparoscopic cholecystectomy (LC) with preoperative endoscopic sphincterotomy (pre-EST) and LC for concomitant gallstones and common bile duct (CBD) stones.

Background: It remains controversial whether LCBDE+LC is better than pre-EST+LC for gallstones and CBD stones.

Methods: A specific search of online databases was performed from January 2006 to October 2017. Relative outcomes of perioperative safety and postoperative efficacy were synthesized. Single-arm meta-analysis and cumulative meta-analysis were also conducted.

Results: A total of 13 studies involving 1757 (872 vs 885) patients were included for analysis in our study. The CBD stones clearance rate [94.1% vs 90.1%; odds ratio (OR) 1.56, P = 0.012] was significantly higher in patients who underwent LCBDE+LC than pre-EST+LC, while perioperative complications (7.6% vs 12.0%; OR 0.67, P = 0.015), conversion to other procedure (4.1% vs 7.1%; OR 0.64, P = 0.025), retained stones rate (1.2% vs 7.9%; OR 0.34, P = 0.004), lithiasis recurrence rate (1.8% vs 5.6%, OR 0.32, P = 0.005), operative time [112.28 vs 132.03 minutes; weighted mean difference (WMD) −18.08, P = 0.002], length of hospital stay (4.94 vs 6.62 days; WMD −1.63, P = 0.023), and total charges [standardized mean difference (SMD) −2.76, P = 0.002] were significantly lower in LCBDE+LC. The mortality (0.6% vs 1.1%; OR 0.32, P = 0.117) was similar between the 2 groups. The cumulative meta-analyses indicated the effect sizes of CBD stones clearance rate, perioperative complications, and conversion to other procedure have already stabilized between 2 groups.

Conclusion: The updated meta-analysis first confirms that LCBDE+LC is superior to pre-EST+LC both in perioperative safety and short- and long-term postoperative efficacy, which should be considered as optimal treatment choice for cholecysto-choledocholithiasis.

*Key Laboratory of Endoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China

Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China.

Reprints: Xiujun Cai, MD, PhD, Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China. E-mail:

Both Long Pan and Mingyu Chen contributed equally to this work.

This work was supported by National Natural Science Foundation of China (No. 81772546); Key Research and Development Plan Projects of Zhejiang Province (No. 2015C03G2010155 and 2017C01018).

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.